Researchers are working on a physical test to pin down diagnosis of ADHD.

Boston Life Sciences, Inc. released details of a human clinical study demonstrating that its diagnostic radioimaging agent, Altropane™, has detected an abnormal elevation in the number of dopamine transporters (DATs) in the brains of subjects with longstanding Attention Deficit Hyperactivity Disorder (ADHD). The study appears in the current issue of the prestigious British medical journal The Lancet.

Dr. Alan Fischman, senior author of The Lancet study, and Chief of Nuclear Medicine at the Massachusetts General Hospital stated, "the findings in this study are very significant, and demonstrate that Altropane potentially could be of great value in establishing the existence of an objective biological abnormality in ADHD."

Upon reviewing the study, psychiatrist Edward Hallowell, M.D, nationally recognized expert in ADHD and author of the book Driven to Distraction, stated, "Altropane is the most promising development I've seen in a long time in terms of our coming up with an actual physical test that could help us pin down the diagnosis of ADHD."

"There is currently great concern among parents, educators and health professionals regarding the accuracy of current psychosocial criteria used to diagnose ADHD, particularly in children, and the related problem of inappropriate use of potentially addictive stimulant medication for this poorly-defined condition. If the positive results obtained in our initial study in adults are further confirmed in children, we expect that Altropane will prove to be of immense value in helping health professionals and parents to deal with these important issues. Given its potential use to objectively diagnose ADHD in students as well as young adults who exhibit symptoms of inattentiveness and hyperactivity, Altropane can also provide a definitive basis for the use of medication in those patients who might otherwise be reluctant to initiate drug therapy," stated Marc Lanser, MD, Chief Scientific Officer of BLSI.

John Heavener, Chief Executive Officer of CHADD, the nation's leading advocacy organization dealing with ADHD stated, "Altropane is potentially a valuable tool in reinforcing the diagnosis of the ADHD, and in providing the public with proof the disorder exists. We receive 200 to 300 calls everyday asking about the diagnosis and treatment of ADHD and we are encouraged that Altropane may be a meaningful tool in advancing the science used to diagnose the disorder."

"To our knowledge, this is the first clinical study to demonstrate that there is a measurable biochemical abnormality in patients with ADHD. In this trial, adult patients with expertly-diagnosed, longstanding ADHD underwent Altropane-SPECT brain scans. In the scan, a Striatal Binding Potential (SBP) was calculated for each patient. The SBP is an indirect measure of the quantity of dopamine transporters (DATs) in the brain. Each and every ADHD patient had a SBP that was at least two standard deviations above the mean SBP of age-matched controls. These results demonstrated that abnormal levels of the DAT are directly associated with the clinical symptoms of ADHD in this patient group," added Dr. Lanser.

Altropane is a small molecule invented by researchers at Harvard and the Massachusetts General Hospital that binds with extremely high affinity and specificity to the DAT. Consequently, the amount of Altropane taken up by the brain is directly proportional to the number of DATs that are present in any given area of the brain. In Parkinson's Disease (PD), there is a marked decrease in the number of DATs in the striatal region of the brain. As a result, Altropane uptake is substantially diminished. This marked decrease in Altropane uptake in PD is the basis for BLSI's diagnostic test for early PD. For this application, Altropane is now in a Phase III trial and if successfully completed, will be submitted for marketing approval next year. Conversely, as now suggested by The Lancet study, ADHD appears to be associated with an excess number of DATs in this same region and thus Altropane has the potential to prove to be a powerful diagnostic for ADHD as well.

ADHD is the most commonly diagnosed behavioral disorder in children and is the fastest growing psychiatric disorder in adults. Since 1990, the total number of American children diagnosed with ADHD has risen from 900,000 to over 5.5 million, and the use of stimulant medication such as Ritalin" has increased 700% in the same period. ADHD is currently diagnosed according to a set of behavioral criteria defined in the Diagnostic and Statistical Manual (DSM) used by psychiatrists. However, it has not been possible to validate these criteria against an objective biological standard, since such a standard has never been established and does not currently exist. Consequently, the DSM criteria have generated widespread concern and, in the view of many critics, often are misapplied and misinterpreted. The lack of a clear-cut, demonstrated biological basis for ADHD has led to a great deal of confusion concerning the diagnosis of ADHD and has even provoked skepticism regarding the very existence of the disorder.

"With 5-10% of approximately 55 million school-age children currently diagnosed with some form of ADHD, roughly 1.5 million initial visits for ADHD per year, and with approximately 1.5 million adults diagnosed with ADHD, the Company believes that Altropane has the potential, if approved, to become one of the largest selling radio-pharmaceutical diagnostics ever developed. We hope to initiate Phase II/III testing for the diagnosis of ADHD early in 2000. The clinical protocol for the ADHD study is currently under review by radioimaging and ADHD experts at the Massachusetts General Hospital and Children's Hospital at the University of Pennsylvania," stated David Hillson, CEO of BLSI."

Source: Press Release from Boston Life Sciences Inc. Please visit their web site for more information.

CBT has been proven to help patients with anxiety disorders confront their fears.

Clinicians who use cognitive-behavioral therapy (CBT) to help patients with anxiety disorders have more treatment success than clinicians who don't, suggest the results of a recent study.

In the study, 165 adults with anxiety disorders, including phobias and panic problems, sought treatment through The Synton Group, a managed behavioral health organization in Lansing, Mich. Of that number, 86 were treated by practitioners with specialized training in cognitive-behavioral therapy (CBT), and they proved to have lower rates of anxiety disorders relapse than others treated by non-CBT practitioners.

CBT clinicians also indicated that their patients had lower levels of anxiety on release from treatment. They typically treated their patients in six sessions, two fewer than their generalist colleagues used.

The CBT specialists were 18 doctoral-level psychologists and two master's-level providers. They indicated that they typically use such CBT techniques as desensitizing patients to the triggers of anxiety, and requiring them to confront their fears. The generalist group of practitioners, including 13 doctoral-level psychologists and 14 master's-level providers, said they used more traditional psychotherapy techniques that delve at what underlies anxiety.

In the two years following treatment, twice as many non-CBT patients as CBT patients--39 percent versus 19 percent--returned for further treatment, despite having had more treatment sessions initially. The study's author, psychologist Rodney C. Howard, PhD, describes that finding as "impressive" and claims it points to CBT's superiority.

"Based on this study, I believe that more clinicians should get cognitive behavioral training to treat anxiety," says Howard, noting that some, but not all, clinical doctoral programs provide it. "With managed care moving toward evidence-based treatment, it's more important to use interventions with demonstrated effectiveness."

Howard admits, however, to a limitation in his study, published in the October issue of Professional Psychology: Research and Practice (Vol. 30, No. 5, p. 470-473). Patients rated their own anxiety levels before treatment, while their therapists reported on those levels afterwards.

Still, "you have to accept some limitations in the real world," says Howard. "I wanted to see what actually happens in practice."

Source: APA Monitor, VOLUME 30, NUMBER 11 December 1999.

next: Diaphragmatic Breathing Technique for Anxiety Sufferers
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Diagnosis of ADHD in preschoolers called into question and worries abound that doctors are prescribing stimulant medications for ADHD to preschoolers when the drugs have never been tested on very young children.

Children age three and under are being diagnosed with attention-deficit hyperactivity disorder (ADHD), in the absence of clear guidelines for this age group, and more than half of these children receive psychotropic medication, according to a report published in the October issue of the Archives of Pediatrics and Adolescent Medicine.

Dr. Marsha D. Rappley and colleagues, from Michigan State University in East Lansing, reviewed the medical claims records of 223 children who had been diagnosed with ADHD at or before the age of 3 years. More than one fourth had been diagnosed at or before the age of 2 years. Boys comprised 79.8% of the sample and 68.2% were white.

Comorbid conditions common among older children with ADHD were reported in 44% of the subjects, most commonly language and cognitive development problems. Other medical conditions were reported in 41%. Forty percent of the children were treated for physical injuries over the 15-month study period.

"These little children clearly have multiple problems, both in mental health and in chronic health," Dr. Rappley said in an interview. "I think primary care physicians want to address their urgent needs, but they don't have the information they need."

Psychological treatment was provided for only 27% of the children.

Psychotropic medications were given to 57%, most frequently methylphenidate and/or clonidine. Just over one third of children receiving medication took two or three psychotropic drugs simultaneously, with thirty different combinations of drugs used. Close to half of the children taking medications took from two to six different drugs over time.

Of particular concern, the authors comment, is that "... the extreme variation in the use of psychotropic medications suggests haphazard use at worst and uninformed use at best." They note that most of the drugs used have not been tested for safety and efficacy in very young children, either singly or in combination.

"When we see 22 different medications used in almost more ways than we could count," said Dr. Rappley, "... this reflects that we don't have guidance on how to use these medications and whether these are the best treatments for very young children."

"As professionals, we need to have a way of describing these children and getting appropriate services for them," she added. "Right now, we don't know how to do that."

Sources:

• Archives of Pediatrics and Adolescent Medicine (Arch Pediatr Adolesc Med 1999;153:1039-1045).

next: ADHD: The Diagnostic Criteria~ adhd library articles~ all add/adhd articles

©1999 The Disability News Service, Inc. by Leye Jeannette Chrzanowski
Wed, Oct 13, 1999

When Joseph A. Rogers, the executive director of the Philadelphia-based Mental Health Consumer's Self Help Clearinghouse (MHCSHC), was asked to review a copy of a chapter in the U.S. Surgeon General's report on mental health labeled "draft," he was shocked to read that electroconvulsive therapy (ECT) is regarded as a safe and effective treatment for depression.

Generally, such reports from the surgeon general are regarded as state of the art research, and are frequently cited as authoritative sources in media reports and professional journals. According to Rogers, at least the ECT section of the draft report on mental health fails to measure up to previous surgeon general reports on smoking and nutrition.

Outraged by the contents of the draft, MHCSHC issued an Internet alert in late September, warning that ECT's efficacy and safety have not been confirmed as stated in the draft report. The alert urged people to contact the surgeon general because the report endorsing ECT would be published later this year if its contents remained unchallenged. The result? The alert garnered national and international media attention. The New York Times, the Newark Star Ledger and Reuters news agency published articles about the draft report, and the office of the surgeon general was swamped by faxes from angry advocates denouncing the endorsement of ECT.

"I hope you understand that is not the surgeon general's draft report, said Damon Thompson a spokesman for the office of the surgeon general, when interviewed on October 12. It is one section of a small portion of proposed language that was given to a person for peer review, asserted Thompson. There is no report yet, and we're still very much in the process of reviewing and revising.

You know what it's like when you turn on the light in a room full of cockroaches and they scurry for cover? That's what it's like, says Rogers, who also questions the limited and questionable sources cited in the document.

The most frequently cited sources were Richard D. Weiner, M.D., Ph.D. and Andrew D. Krystal, M.D. Weiner heads Duke University Medical Center's Electroconvulsive Therapy Service and the American Psychiatric Association (APA) Task Force on ECT, which petitioned the Food and Drug Administration to lower its classification of ECT machines in 1982. Krystal, director of Duke's Sleep Disorder Center, received $150,036 in funding from the National Institutes of Mental Health (NIMH) in fiscal year 1998 to conduct research on improving ECT's effectiveness.

Clearly, the surgeon general's office simply did not do its homework, since there is a vast quantity of material that indicates that ECT is not safe, states the MHCSHC alert.

Rogers further asserts that the committee members who prepared the document cite old recycled information and ignore numerous sources which contradict the position that ECT is safe. They were asleep at the switch on putting out a cutting edge document for the surgeon general, says Rogers. He adds the surgeon general should be angry at the committee for turning out "sloppy work."

A NIMH fact sheet on depression posted on the federal agency's Internet Web site on April 13, 1999 also endorses ECT as one of the most effective treatments for depression. The fact sheet states:

Eighty to ninety percent of people with severe depression improve dramatically with ECT. ECT involves producing a seizure in the brain of a patient under general anesthesia by applying electrical stimulation to the brain through electrodes placed on the scalp.

Repeated treatments are necessary to achieve the most complete antidepressant response. Memory loss and other cognitive problems are common, yet typically short-lived side effects of ECT. Although some people report lasting difficulties, modern advances in ECT technique have greatly reduced the side effects of this treatment compared to earlier decades. NIMH research on ECT has found that the dose of electricity applied and the placement of electrodes (unilateral or bilateral) can influence the degree of depression relief and the severity of side effects.

Yet, the above assertion that the side effects of ECT are short-lived, and that ECT is safe, as stated in the surgeon general's draft document, appear to contradict the Electroconvulsive Therapy Background Paper published in 1998 by U.S. Department of Health and Human Services (HHS). The paper states that in 1985 the National Institute of Mental Health Consensus Development Conference on ECT identified five priority research tasks, but thirteen years later, many were not completed.

While many studies of ECT have been undertaken since the 1985 Consensus Development Conference on ECT, the issues regarding brain damage and memory loss have not yet been fully explored or understood, concludes the 1998 HHS document.

next: ECT: Sham Statistics, the Myth of Convulsive Therapy, and the Case for Consumer Misinformation
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

WESTPORT, Oct 13 1999 (Reuters Health) - The vast majority of patients who undergo electroconvulsive therapy report that they are satisfied with its results.

"Many people assume that electroconvulsive therapy is something that is done despite the patient and their family preferring other treatment," investigator Dr. Lois E. Krahn, of Mayo Clinic Rochester in Minnesota, said in an interview with Reuters Health. On the contrary, she said, patients responding to a recent survey "...for the most part...were satisfied with their treatment."

Dr. Krahn and colleagues at the clinic surveyed a consecutive series of 24 psychiatric inpatients immediately after and 2 weeks after electroconvulsive therapy to determine their satisfaction with the procedure. The team used a modified version of the survey to investigate attitudes toward electroconvulsive therapy in 24 psychiatric outpatients who had never received the treatment.

Dr. Krahn told Reuters Health that all electroconvulsive therapy-treated patients had undergone prior pharmacologic therapy with either a poor response or unacceptable rate of side effects.

Of the treated patients, 91% responded "mostly true" or "definitely true" to the statement "I am glad that I received [electroconvulsive therapy]," Dr. Krahn and colleagues report in the October issue of Mayo Clinic Proceedings.

Those positive attitudes toward the procedure persisted for at least 2 weeks. Patients who reported being satisfied with the treatment were generally younger than dissatisfied patients and had attained higher levels of education. Treated patients had better attitudes toward electroconvulsive therapy than did controls who had never received such treatment.

"The degree of satisfaction may be surprising to the public and nonpsychiatric clinicians as well as to psychiatrists who are ambivalent about [electroconvulsive therapy]," the researchers write. Dr. Krahn acknowledged in the interview with Reuters Health that she, too, was "pleasantly surprised" by the proportion of patients who were satisfied with electroconvulsive therapy, although she had anticipated that many patients would be satisfied

The investigators note in the journal that further research is needed to assess satisfaction with electroconvulsive therapy over a longer term and to examine satisfaction in patients who are cognitively impaired.

In the meantime, Dr. Krahn told Reuters Health, she plans to use the new data when she counsels patients considering electroconvulsive therapy. Together with other information on the procedure, the new findings may aid patients in making informed decisions about electroconvulsive therapy, she believes.

Mayo Clin Proc 1999;74:967-971.

next: Psychiatric Facilities
~ all Shocked! ECT articles
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~ all articles on depression

I had an interesting and humorous experience with God while meditating. First off, let me just say I have never really meditated in any kind of serious or consistent way. I'm not very good at it. It's been a struggle for me to quiet my mind and I was never quite sure of its purpose. I couldn't quite grasp the concept of doing something with no expectations or goals.

"Like waves rolling up a beach to stillness."

I've read how great and helpful meditating has been for many people. I wanted to experience what they were experiencing even though I wasn't exactly sure what that was! Here's what happened.

I laid down in a recliner, closed my eyes and began focusing on taking deep breaths. As I became more and more relaxed, I became less aware of my body. I can't say my mind was completely quiet. Thoughts were there but they would drift away and become elongated like a wave rolling up the beach to stillness. I focused on those quiet moments between my thoughts trying to stretch them out in time. Throughout the mediation I would see things. Mostly shapes, dark purple clouds, flashes of light, it was almost psychedelic. I tried to focus on the shapes but as soon as I would, they would evaporate into the mist.

In my mind's eye I looked over and God was sitting on our couch. He was this guy in his mid-fifties with speckled gray and brown hair, beard, and wearing this white robe. The typical robe God is portrayed as wearing in a lot of religious imagery. But this guy was different. He was very relaxed and laid back. He was kinda slouched down with his arms resting on the back of the couch and his legs were crossed. He looked like any average Joe relaxing on a Sunday afternoon watching football. AND.I could have sworn I saw blue jeans peaking out from under his robes! I chuckled to myself thinking how different this image was from how I was raised to believe God would appear.

When he looked over at me we shared one of those "friend moments." You know the kind where you look at each other and it feels like you're sharing something special and secret between the two of you. I felt the connection. We both smiled knowingly at each. It was such a warm, familiar, and comfortable feeling.

continue story below

I let the image go and went back to "trying to meditate" which I thought meant not thinking or seeing anything. But another image appeared in my mind. I saw myself sitting in the classic lotus position, crossed legged, straight-backed with my arms outstretched resting on my knees, my thumbs and forefingers gently meeting. I tried to imagine what those "yogis" must be experiencing when in this pose. I so badly wanted to experience this place of "oneness" so many gurus reference in their descriptions.

Again, I looked over in my mind's eye to the couch. God was sitting there in the exact same lotus position I imaged myself to be sitting. It's almost like he was pantomiming or mocking me, but in a very loving way! He opened one of his eyes to see if I was looking. When our gazes met, we both busted out laughing.

Without opening his mouth to speak, and with a hint of remaining laughter in his voice(?) he said to me, "Jenn, you don't have to meditate like other people, whatever way you mediate IS the right way for you. It's not about sitting in the right position or exercising the correct technique, it's about quieting and slowing down your body and mind enough to create an open space. In that space you'll hear the pin drop that is me."

His style of communicating this message was absolutely perfect. He was so gentle. His use of humor defused the stress and worry I generally feel regarding "doing it right." Perhaps that's what made the situation so funny to me.

Upon reflection I realized how often I have look to others to tell me the "proper" or "correct" way to go about living life. Most of my life I've assumed there was one right way to do things and I desperately wanted to know what that way was. It felt like I had missed an important memo from the front office. Everyone else received it, but not me and since then I've been scrambling to catch up with what everyone else knows.

After this experience I'm much more inclined to ask myself "what do I think? What do I believe? Is this true for me?" I no longer take what others say as "the law." I question everything and find my own answers. I'm still an avid reader but authors' words are no longer cut in stone. I am now the final gateway to answers.

Thank you God for approaching me in such a fun and clear way!

next: Dialogue With God On Money~ back to: My Articles: Table of Contents

Documentary broadcast on Showtime, Sept. 13, 1999. Directed by Robert Zemeckis.

next: What Personality Traits do Children of Alcoholics Inherit?
~ all Stanton Peele articles
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Both genetics and structural brain makeup play a role in development of ADHD and symptoms of impulsive and inattentive behavior. Bad parenting though can lead to antisocial conduct.

Taylor E.
Institute of Psychiatry, Kings College, London, UK

Recent research on the disorders of attention and activity has indicated inherited variants of genes controlling aspects of neurotransmission, abnormalities of structure and function in regions of frontal lobes and basal ganglia, failures to suppress inappropriate responses, and a cascade of failures in various kinds of cognitive performance and organization of behavior.

This review integrates the neurodevelopmental findings with findings from developmental psychopathology. It outlines several developmental tracks by which constitutional factors interact with the psychological environment.

In one set of tracks, altered brain states lead to cognitive alteration. An understimulating environment is evoked by (and may be genetically associated with) an inattentive and cognitively impulsive style during early childhood.

In another track, impulsive and inattentive behavior shows direct continuity through childhood into late adolescence.

In yet another track, impulsiveness evokes (and may be genetically associated with) critical expressed emotion from parents and inefficient coping strategies, which in turn contribute to the development of antisocial conduct.

This formulation emphasizes the need for several types of research: the mapping of biological findings onto different components of disorder, the combination of genetically informative designs with direct measurement of relevant aspects of the environment, and the use of longitudinal studies to examine predictive and mediating factors separately for different aspects of outcome.

Source: Development and Psychopathology (1999), 11: 607-628 Cambridge University Press doi:10.1017/S0954579499002230

Behavioral signs that indicate your child or teen may find a psychiatric evaluation beneficial.

Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family.

Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful.

Younger Children

• Marked fall in school performance.
• Poor grades in school despite trying very hard.
• A lot of worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child's age.
• Hyperactivity; fidgeting; constant movement beyond regular playing.
• Persistent nightmares.
• Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures.
• Frequent, unexplainable temper tantrums.

Pre-Adolescents and Adolescents

• Marked change in school performance.
• Inability to cope with problems and daily activities.
• Marked changes in sleeping and/or eating habits.
• Many physical complaints.
• Sexual acting out.
• Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death.
• Abuse of alcohol and/or drugs.
• Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating.
• Persistent nightmares.
• Threats of self-harm or harm to others.
• Self-injury or self destructive behavior.
• Frequent outbursts of anger, aggression.
• Threats to run away.
• Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism.
• Strange thoughts and feelings; and unusual behaviors.

If problems persist over an extended period of time and especially if others involved in the child's life are concerned, consultation with a child and adolescent psychiatrist or other clinician specifically trained to work with children may be helpful.

Source: American Academy of Child and Adolescent Psychiatry, Sept. 1999

next: Parents Dealing with Children's Anxiety
~ anxiety-panic library articles
~ all anxiety disorders articles

Internet addiction expert, Dr. Kimberly Young delves into the psychology of Internet addiction.

KIMBERLY S. YOUNG
University of Pittsburgh at Bradford

A Case that Breaks the Stereotype

SUMMARY

This case involves a homemaker 43 years of age who is addicted to using the Internet. This case was selected as it demonstrates that a nontechnologically oriented woman with a reportedly content home life and no prior addiction or psychiatric history abused the Internet which resulted in significant impairment to her family life. This paper defines addictive use of the Internet, outlines the subject's progression of addictive on-line use, and discusses the implications of such addictive behavior on the new market of Internet consumers.

This research note concerns the case of a 43-yr.-old homemaker whom the author recently interviewed as part of a larger study designed to examine addictive use of the Internet (Young, 1996). Media attention on the subject of "Internet addiction" has stereotyped those who become addicted as predominantly young, introverted, computer-oriented males. Further, prior research has indicated that predominantly object-oriented introverted males become computer addicted (Shotton, 1989, 1991), and educational specialists have shown that women report lower self-efficacy than men when asked about their use of information technologies (Busch, 1995). In contrast to these observations, this case was selected from the author's original study, as it demonstrates that a nontechnologically oriented woman with a self-reported content home life and no prior addiction or psychiatric history, abused the Internet which resulted in significant impairment to her family life.

DEFINING ADDICTION

The original project was initiated based upon reports which indicated that some on-line users were becoming addicted to the Internet in much the same way that others became addicted to drugs, alcohol, or gambling. The way to clinically define addictive use of the Internet is to compare it against criteria for other established addictions. However, the term addiction does not appear in the most recent version of the DSM-IV (American Psychiatric Association, 1995). Of all the diagnoses referenced in the DSM-IV, substance dependence may come the closest to capturing the essence of what has traditionally been labeled addiction (Walters, 1996) and provides a workable definition of addiction. The seven criteria considered under this diagnosis are withdrawal, tolerance, preoccupation with the substance, heavier or more frequent use of the substance than intended, centralized activities to procure more of the substance, loss of interest in other social, occupational, and recreational activities, and disregard for the physical or psychological consequences caused by the use of the substance.

While many believe the term addiction should only be applied to cases involving chemical substances (e.g., Rachlin, 1990; Walker, 1989), similar diagnostic criteria have been applied to a number of problem behaviors such as pathological gambling (Griffiths, 1990; Mobilia, 1993; Walters, 1996), eating disorders (Lacey, 1993; Lesieur & Blume, 1993), sexual addictions (Goodman, 1993), generic technological addictions (Griffiths, 1995), and video game addiction (Griffiths, 1991,1992; Keepers, 1990; Soper, 1983). Therefore, in the original study was developed a brief seven-item questionnaire which adapted similar criteria for substance dependence in the DSM-IV to provide a screening measure of addictive use of the Internet (Young, 1996). If a person answered "yes" to three (or more) of the seven questions, the person was deemed to be an Internet "addict." It should be noted that the term Internet is used to denote both the actual Internet and on-line service providers (e.g., America Online and Compuserve) in this paper.

A CASE STUDY

This subject reported that despite being 'computer phobic and illiterate," she was able to navigate easily through the on-line system of her new home personal computer because of the menu-driven applications provided by her on-line service. Her on-line service was the only application for which she used her computer, and she initially spent a few hours per week scanning a variety of social chat rooms, i.e., these are virtual communities which allow multiple on-line users to converse or "chat" instantly with one another in real time. Within a 3-mo. period, the subject gradually needed to spend longer periods of time on-line, which she estimated to reach a peak of 50 to 60 hours per week. She explained that once she became established in a particular chat room where she felt a sense of community among other on-line participants, she frequently stayed on-line longer than she intended, e.g., two hours, reporting sessions lasting up to 14 hours. Typically, she logged on the first thing in the morning, she constantly checked her e-mail throughout the day, and she stayed up late using the Internet (sometimes till dawn).

She eventually felt depressed, anxious, and irritable whenever she was not in front of her computer. In an effort to avoid what she referred to as "withdrawal from the Internet," she engaged in activities to stay on-line as long as she could. The subject canceled appointments, stopped calling real life friends, reduced her interpersonal involvement with her family, and quit social activities she once enjoyed, e.g., bridge club. Further, she stopped performing routine chores, such as the cooking, cleaning, and grocery shopping, that would take her away from being on-line.

The subject did not see her compulsive use of the Internet as a problem; however, significant family problems developed subsequent to her overuse of the Internet. Specifically, her two teenage daughters felt ignored by their mother, as she was always sitting in front of the computer. Her husband of 17 years complained about the financial cost of the on-line service fees which he paid (up to $400.00 per month), and about her loss of interest in their marriage. Despite these negative consequences, the subject denied that this behavior was abnormal, had no desire to reduce the amount of time she spent on-line, and refused to seek treatment despite repeated requests from her husband. She felt it was natural to use the Internet, denied anyone could be addicted to it, felt her family was being unreasonable, and found an unique sense of excitement through on-line stimulation that she would not give up. Her continual overuse of the Internet eventually resulted in becoming estranged from her two daughters and separated from her husband within one year of the purchase of her home computer.

The interview with this subject took place six months subsequent to these events. At that time, she admitted having an addiction to the Internet "like one would to alcohol." Through the loss of her family she was able to reduce her own use of the Internet with no therapeutic intervention. However, she stated that she was unable to eliminate on-hne use completely without external intervention nor was she able to reestablish an open relationship with her estranged family.

DISCUSSION

Given the recent surge in access to information technologies (Graphics, Visualization, and Usability Center, 1995), we have a new generation of diverse computer users. As this case suggests, contrary to the stereotype of a young, male, computer-savvy on-line user as the prototypic Internet "addict," new consumers of the Internet who do not match this general stereotype are just as susceptible. Given the severity of the family impairment in this case, future research should focus on the prevalence, characteristics, and consequences of this type of addictive behavior.

This case suggests that certain risk factors may be associated with the development of addictive use of the Internet. First, the type of application utilized by the on-line user may be associated with the development of Internet abuse. The subject in this case became addicted to chat rooms which is consistent with prior research that has found highly interactive applications available on the Internet (e.g., virtual social chat rooms, virtual games called Multi-user Dungeons played in real time simultaneously with multiple on-line users) to be most utilized by its consumers (Turkle, 1984, 1995). Research may document that, in general, the Internet itself is not addictive, but perhaps specific applications play a significant role in the development of Internet abuse. Secondly, this subject reported a sense of excitement when using the Internet which can be paralleled to the "high" experienced when people become addicted to video games (Keepers, 1990) or gambling (Griffiths, 1990). This implies that the level of excitement experienced by the on-line user while engaged in the Internet may be associated with addictive use of the Internet.

Based upon the issues raised here, it would be beneficial to adapt the brief questionnaire (Young, 1996) for use in classifying cases of such Internet abuse. By monitoring such cases, prevalence rates, further demographic information, and implications for treatment can be obtained. More significantly, one may show whether this type of behavior is implicated in or acts as a substitute for other established addictions, e.g., chemical dependencies, pathological gambling, sexual addictions, or if it is a co-morbid factor with other psychiatric disorders, e.g., depression, obsessive-compulsive disorders.

next:Internet Addiction: Symptoms, Evaluation, And Treatment
~ all center for online addiction articles
~ all articles on addictions

REFERENCES

AMERICAN PSYCHIATRIC ASSOCIATION. (1995) Diagnostic and statistical manual of mental disorders. (4th ed.) Washington, DC: Author.

BUSCH, T. (1995) Gender differences in self-efficacy and attitudes toward computers. Journal of Educational Computing Research, 12,147-158.

GOODMAN, A. (1993) Diagnosis and treatment of sexual addiction. Journal of Sex and Marital Therapy, 19, 225-251.

GRAPHICS, VISUALIZATION, AND USABILITY CENTER.(1995) Online Access, March Issue, 51-52.

GRIFFITHS, M. (1990) The cognitive psychology of gambling. Journal of Gambling Studies, 6, 31-42.

GRIFFITHS, M. (1991) Amusement machine playing in childhood and adolescence: a comparative analysis of video game and fruit machines. Journal of Adolescence, 14, 53-73.

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